Child and Adolescent Clinic - Babies and Honey

Ask Dr. Sue

BABIES AND HONEY; BABIES AND BATHTUB

Dear Dr. Sue,

I have two questions for you.

1. At what age is it safe to feed honey to babies? Can babies under that age be given honey in cooked products, like graham crackers?

2. At what age is a child safe alone in the bathtub?

Dear Mom,

Babies under a year of age are not to be fed RAW honey, definitely. (Raw honey is defined as
honey that has not been cooked.) Raw honey is believed to be a risk for infant botulism, which is a rare but very serious disease which causes severe muscle weakness including the inability to cry or suck, a floppy neck, constipation, and rarely death. This disorder has never been reported in a baby over a year of age. Many of the babies who developed this disorder had never even been fed honey, by the way, but botulinum spores have been found in honey, so it's important to avoid this possible source. Other cases may have been caused by spores in other foods or in soil, or some as yet unrecognized source. Babies are thought to be at greater risk from these spores because their gastrointestinal tracts have lower acidity, which can allow the spores to survive and grow. There may be other factors involving their immune system that contribute to their risk, as well. There is speculation recently that as many as five to ten percent of so-called SIDS deaths may have been undetected infant botulism!

Some sources say that cooked honey is safe for babies under a year of age. We know that boiling
for ten minutes kills the spores and inactivates any toxin that has been produced. These spores
are rather heat resistant, though, and baking does not produce such high temperatures for a full ten minutes. Many sources, including the American Academy of Pediatrics, simply say that babies under a year of age should not be fed honey "in any form," and this seems like the safest course of action.

Regarding bathtub safety: there really is no clear-cut age at which your child is safe unsupervised in the bath. You know that an eight-year old doesn't need supervision, and a two-year old does. It's hard to define an age in-between that would work for every child. I'll give you some information that might help you make your own decisions in this regard, though. Most of the bathtub deaths that have been studied recently involve the use of infant bath seats, because these seats have become a hot safety topic. (NEVER leave your BABY alone in the bathtub, with or without a seat; these seats do not prevent drowning.) In one study of 78 bathtub drowning deaths, the range in age was from five to twenty months, with an average age of eight months. Drowning deaths overall occur more in the under five age group than in kids older than five. Remember that drowning in small children is often a silent death, with no screaming or splashing to alert you.

Remember that drowning can occur in the toilet, in an unattended bucket of water, or in your
decorative fountain in the yard, too. The same safety rules apply to any standing water.

Remember also that the bathtub represents a few safety hazards other than drowning. Your child
could turn on the hot water tap and scald himself. He could decide he's done and try to climb out of the slippery tub, inviting a serious head injury. He could decide to drink a bottle of shampoo. If in doubt, its best again to err on the side of caution, and watch him until you feel certain he's not at risk from any of these dangers.

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